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Neck Pain Treatment

Neck Pain Without Radiculopathy:

  • Acute neck pain usually improves spontaneously. Goals of treatment include pain relief and quick return to normal activity.
  • First-line treatments: NSAIDs, acetaminophen, heat/cold therapy, and muscle relaxants like cyclobenzaprine for sleep-related symptoms.
  • Supervised exercise programs that include neck stretches and shoulder rolls can help alleviate symptoms.
  • Evidence does not support treatments such as cervical traction, TENS, ultrasound, or trigger point injections for neck pain.

Neck Pain With Radiculopathy:

  • Often caused by cervical disk herniation or spondylosis with nerve compression.
  • NSAIDs and acetaminophen are reasonable first steps for pain relief. Glucocorticoids (oral or epidural) may be used for more severe cases.
  • Surgery, such as anterior cervical diskectomy or laminectomy, is reserved for progressive motor deficits, spinal cord compression, or pain unresponsive to conservative therapy.
  • Patients with cervical spondylosis and foraminal narrowing may require periodic follow-up to assess progression.

Trauma to the Cervical Spine

  • Whiplash injuries: Often result from rapid neck movement (e.g., car accidents), causing facet joint injury. Persistent pain beyond 6 weeks warrants further evaluation.
  • Cervical fractures or subluxations: Can lead to spinal cord injury. CT is preferred for fracture detection, and immediate immobilization is critical to prevent further damage.

Other Causes of Neck Pain

  • Rheumatoid arthritis (RA): Can affect the atlantoaxial joint (C1-C2), leading to subluxation and potential spinal cord compression.
  • Ankylosing spondylitis: Causes chronic inflammation, potentially leading to atlantoaxial subluxation.
  • Neoplastic infiltration, infections, and metabolic bone diseases: Also contribute to neck pain and may require more specialized treatments.

Thoracic Outlet Syndromes

  • True neurogenic thoracic outlet syndrome (TOS): Caused by compression of the lower brachial plexus (C8/T1), leading to muscle wasting and sensory loss. Treated surgically by resecting the anomalous band.
  • Arterial TOS: Compression of the subclavian artery, leading to embolic complications. Treatment involves anticoagulation and surgical excision.
  • Venous TOS: Subclavian vein thrombosis, diagnosed by venography, and treated with thrombolysis or surgery.

Brachial Plexus and Nerves

  • Injuries to the brachial plexus or peripheral nerves can mimic cervical spine pain, but symptoms generally begin in the shoulder girdle or upper arm.
  • Brachial neuritis: Presents with acute pain followed by weakness, particularly in the shoulder muscles. Recovery can take up to 3 years.
  • Carpal tunnel syndrome, radial nerve lesions, or ulnar nerve injuries: Can mimic radiculopathy and are best diagnosed with EMG and nerve conduction studies (NCS).

Shoulder Pain

  • Shoulder disorders, such as rotator cuff tears, bicipital tendonitis, and frozen shoulder, can mimic cervical spine pathology.
  • Mechanical shoulder pain is often worse at night and can be exacerbated by passive shoulder movements.
  • Differentiating shoulder pain from cervical radiculopathy involves examining the range of motion and the presence of focal neurological deficits.

This concludes the treatment strategies and key points for both back and neck pain, outlining the common causes, diagnostic approaches, and therapeutic interventions for acute and chronic conditions. The emphasis remains on conservative management for most cases, reserving surgery for more severe or refractory cases.